SYSTEMIC LUPUS ERYTHEMATOSUS Flashcards
epidemiology of systemic lupus erythematosus
M:F 1:9
more prev in women as autoimmune
15-40yrs
more prevelent in afro caribbean, asian, chinese
what are the clinical features of lupus?
present- Malaise, fatigue, fever, weight loss, Lymphadenopathy
Butterfly rash, alopecia (hair loss)
Arthralgia
Raynaud’s phenomenon
inflammatio of kidney, CNS,heart,lungs
Accelerated atherosclerosis
Vasculitis
describe the immunology of SLE
chronically active innate immune response switches to an acute response
complement mediated tissue damage
apoptotic cells are not significantly cleared by phagocytes which leads to failure to clear autoantigens
how would you diagnose SLE
send serum for antinuclear antibodies
presence of antibodies that will bind self nuclei
antibodies that bind to double stranded
some antibodies bind to snp single stranded DNA /RNA
check for complement proteins in the blood. reduced levels of C3 and C4 indicates increased complement rate due to them being consumed rapidly in a lupus patient
how is the disease divided in terms of severity?
mild- joint/skin
moderate- inflammation of other organs (pleuritis, pericarditis, mild nephritis)
severe- severe inflammation in vital organs
hoe do you treat lupus?
- NSAIDs
paracetamol - Hydroxychloroquine
- corticosteroids (only once other treatments have failed)
give examples of drugs to treat severe lupus
Azathioprine
-steroid sparing agent
cyclophosphamide (severe organ involvement)
-effective drug but side effects inc reduced fertility
Mycophenolate mofetil
(• Reversible inhibitor of inosine monophosphate dehydrogenase
• Rate-limiting enzyme in de novo purine synthesis
• Lymphocytes – dependent upon de novo purine synthesis)
Rituximab
- anti CD20 ab therapy
- leads to depletion of B cells
what is the prognosis of lupus?
15year survival:
no nephritis (85%)
nephritis (60%)
prognosis also worse if male or black
what is lupus
Autoimmune Multisystem Disease
